• Journal of Chest Surgery
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• v.17 no.4
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• pp.691-697
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• 1984

After the real birth of vascular surgery occurred with the introduction of the first practical arterial prosthesis about 50 years ago, a variety of potential vascular graft had been tested and rejected. Polytetrafluoroethylene [Teflon, PTFE] was first used as a vascular prosthesis in 1957. Thereafter this pros-thesis was first used clinically in 1972 and has subsequently been widely applied as a small and medium sized vessel replacement because it is easy to use and readily available. There are numerous reports of good results about Polytetrafluoroethylene graft. We experienced the three cases of arterial bypass graft using polytetrafluoroethylene vascular pros-thesis. First, 21 years old female patient had suffered from Takayasus disease which affected the left subclavian artery and right subclavian-left axillary extra anatomical bypass graft as done. Second, 64 years old male patient had suffered from Leriche syndrome for 12 years and the left axillofemoral and femorofemoral extra anatomical bypass graft was done. Third, 34 years old male patient had suffered from recurrent Buergers disease which affected the left popliteal artery and the isolated popliteal artery segment bypass graft was done. Relatively satisfactory result was obtained in early post-operative period in all three cases.

• Journal of Biomedical Engineering Research
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• v.17 no.2
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• pp.255-262
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• 1996

Antithrombogenic surFace is one of the most important things to the artificial vascular prostheses. This problem will be solved if the surface of prosthesis is covered with endothelial cells. The attachment and the growth of endothelial cells onto vascular prosthesis are very difficult. So many studies have been concentrated on the attachement of endothelial cell. But no good performance of the in uiwo experiments has been shown until now. In this study, we used the whole extracellular matrix (ECM) excreted from fibroblasts as an underlying matrix, and the endothelial cells were seeded to obtain the long term patency of vascular graft(i.e., for the patent 8 week implanted wafts in the animal model of rat). In order to study the antithrombogenic functions of cultured endothelial cells, prostaglandin(PGF 1 a) synthesis and platelet adhesion were assayed. The concentration of PGF a of stimulated group was sisnificantly higher than that of control group(21.97 $\pm$ 3.45 vs 4.93 $\pm$0.71 pg/1000 cells). The platelet adhesion of the polyurethane sheet covered with endothelial cells was lower than that of polyurethane sheet or sheet covered with ECM(1.04$\pm$0.28, 2.87$\pm$0.77, 2.89$\pm$0.70, % radioactivities, respectively). Endothelial cells grew well on polyurethane coated with ECM, synthesized the prostacyclin and functioned well as antithrombogenic. Therefore the endothelialization onto the ECM excreted from fibroblasts may be a good method for the vfudig prosthesis.

• Journal of Chest Surgery
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• v.28 no.6
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• pp.557-564
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• 1995

Microvel knitted double velour vascular grafts coated with biodegradable algin were evaluated in the canine experimental model as a new biologically coated Dacron graft. Three series of implantations were conducted involving the insertion of 6 mm diameter grafts in the abdominal aortae of mongrel dogs. The first series used the regular Microvel vascular grafts coated with algin,whereas the second and third series used Hemashield [collagen-coated grafts and the regular Microvel grafts with preclotting,respectively as control groups. Each series involved the implantation of one prosthesis for each of 2 preselected periods,namely 3 months and 6 months. In addition,algin-impregnated grafts were implanted for 4 hours,72 hours,2 weeks,and 4 weeks. All grafts were patent when the animals were sacrificed at intervals ranging from 4 hours to 6 months. Histological examinations revealed no obvious or significant differences in the healing characteristics of the algin-coated grafts and the control grafts after 3 months and 6 months of implantation. Endothelial cell-like cells were present on the midsegments of all grafts explanted from animals sacrificed after 3 months and 6 months,except a suspicious finding in the 3 month-implantation animal of a preclotted graft. With special stains,the algin became invisible between the polyester filaments during the first 3 months of implantation. This study has demonstrated that the use of a biodegradable algin coating is a feasible approach as biological sealants for textile arterial prostheses.

• Journal of Chest Surgery
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• v.48 no.5
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• pp.371-374
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• 2015

We present a rare case of a patient with aortoiliac occlusive disease on the background of type A crossed renal ectopia, for whom open surgical intervention was required. Aortic exposure in patients with concomitant crossed renal ectopia can present technical challenges to the vascular surgeon. The knowledge of variations in the ectopic renal blood supply is of paramount importance when performing surgery to treat this condition and affects the choice of surgical exposure. We present and discuss the operative details of our patient and outline an approach to this subset of patients.

• Journal of Korean Physical Therapy Science
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• v.12 no.4
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• pp.89-97
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• 2005

Objective: The purpose of this study was to access quality of life and evaluate pre and post surgery management for persons with lower limb amputations. Method: This study was designed as a telephone survey. The subjects were patients who underwent their lower limb amputation between January 1994, and February 2005 at Asan Medical Center in seoul. sixty one of 203 subjects had granted consent and were studied. Results: The major cause of below knee amputations was vascular disease. Traumatic injuries were more common among subjects with above knee amputations. 93.4% of subjects were in use of prosthesis and 70.1 days were required to fit the prosthesis. 68.4% of subjects were able to ambulate with single point cane or without assistive devices. 80.3% of subjects complained phantom pain. Most subjects expressed the unsatisfactory result regarding the functional usage of prosthesis and education from hospital. Conclusion: Pre and post surgery rehabilitation program will benefit to promote better functional status and quality of life for persons with lower limb amputations.

• Journal of Chest Surgery
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• v.36 no.2
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• pp.63-72
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• 2003

Although a variety of synthetic vascular grafts are available in modern vascular surgery, no ideal prosthesis ha,4 yet been developed. Small-caliber vascular grafts with low flow, as used in the lower extremity, continue to become thrombosed at unacceptable rates. We have developed and evaluated the new antithrombogenic blood contacting surfaces in canine model. Material and Method: Two now antithrombogenic blood contacting surfaces(Polyvinylalcohol -Polyurethane(PVA-PU) blend and natural Graphite-polyurethane(G-PU) blend) have been developed and evaluated in canine model, using vascular grafts and patches. The luminal surfaces of the test vascular grafts(5 mm ID) were fabricated by dipping a glass rod in PVA-PU blend solution(50 % PVA) using phase separation method. Mongrel dogs of either sex weighing 18-22 kg were anesthetized by endotracheal intubation using halothane and their lungs were ventilated with a volume-cycled ventilator, Maintenance anesthesia with 0.5-1.0% halothane and supplemental oxygen was used. Two pairs were used for comparison in the bilateral femoral arteries for both vascular grafts(PVA-PU vs. PU) and vascular patches(G-PU vs. PU). Bilateral groin incisions were made and the arteries were exposed and clamped. After an excision of 1 cm of the artery between clamps, a grail of 2.5 cm in length was implanted end-to-end using 6-0 polypropylene suture. The vascular patch was implanted as a form of on-lay patch. Animals were sacrificed at 1, 2, 4, 6, 8 and 16 weeks for vascular grafts and 1, 2. 4 and 6 weeks for vascular patches. Result The vascular grafts of PVA-PU blends showed patent lumina in the 2 and 16 weeks animals, while those of PU showed a patent lumen in 2 weeks animal. PVA-PU graft of 16 weeks showed a fairly clean luminal surface. A light microscopic finding of this graft demonstrated good tissue infiltration through porosity, The animals with vascular patches showed patent arteries in both groups except 2 weeks animal. Scanning electron microscopy of the luminal surfaces of G-PU patches in 4 and 6 weeks animals showed endothelial cell covering with microvilli. PU patches showed qualitatively less endothelial cell covering. Conclusion: In conclusion, PVA-PU and G-PU blends can be a promising blood contacting surfaces for application in a synthetic vascualr graft. However, further animal study is needed to determine the real long-term effects of these methods of surface modifications.

• Journal of Chest Surgery
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• v.54 no.3
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• pp.191-199
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• 2021

Background: Tracheal replacement is a challenge for thoracic surgeons due to stenosis in the trachea-prosthesis anastomosis. We propose that stenosis occurs due to fibrosis as a result of an abnormal healing process, characterized by an increased expression of wound healing growth factors (vascular endothelial growth factor [VEGF], survivin, and CD31), which promote angiogenesis and decrease apoptosis. We analyzed the immunoreactivity of VEGF, survivin, CD31, and caspase-3 in the development of fibrotic stenosis in prosthetic tracheal replacement. Methods: Fourteen dogs were operated on: group I (n=7) received a 6-ring cervical tracheal segment autograft, while in group II (n=7), a 6-ring segment of the cervical trachea was resected and tracheal continuity was restored with a Dacron prosthesis. The follow-up was 3 months. Immunoreactivity studies for VEGF, survivin, CD31, and caspase-3 were performed. A statistical analysis was done using the Wilcoxon signed rank test. Results: Four animals in group I were euthanized on the 10th postoperative day due to autograft necrosis. Three animals completed the study without anastomotic stenosis. Moderate expression of VEGF (p=0.038), survivin (p=0.038), and CD31 (p=0.038) was found. All group II animals developed stenosis in the trachea-prosthesis anastomotic sites. Microscopy showed abundant collagen and neovascularization vessels. Statistically significant immunoreactive expression of VEGF (p=0.015), survivin (p=0.017), and CD31 (p=0.011) was observed. No expression of caspase-3 was found. Conclusion: We found a strong correlation between fibrosis in trachea-prosthesis anastomoses and excessive angiogenesis, moderate to intense VEGF, CD31, and survivin expression, and null apoptotic activity. These factors led to uncontrolled collagen production.

• Journal of Chest Surgery
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• v.19 no.1
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• pp.58-67
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• 1986

Aggressive revascularization of the ischemic lower extremities in atherosclerotic, occlusive diseases or acute embolic arterial occlusion due to cardiac valvular disease by thromboembolectomy or an arterial bypass operation has been advocated by some authors. We have performed 68 first time vascular operations, including thromboembolectomies on RR patients with ischemic lower extremities, within an 11-year-and-6-month period, from January 1974 to June 1984. We have reviewed and analyzed our vascular operative procedures and post operative results. The patients upon whom thromboembolectomies were performed were 42 males and 13 females ranging from 5 to 72 years of age. The major arterial occlusive sites were common iliac artery in 20 cases, femoral artery in 21 cases, popliteal artery in 8 cases, common iliac artery and femoral artery in 4 cases, and femoral artery and popliteal artery in 3 cases. The underlying causes of arterial occlusive disease were atherosclerosis obliterans in 34 cases; Buerger`s disease in 3 cases; emboli due to cardiac valvular disease in 13 cases; and vascular trauma in 4 cases, including cardiac catheterization in I of those cases. Arterial bypass operations with autogenous or artificial vascular prosthesis were done in 31 cases. Amputations were done on 2 patients carrying out any more vascular operative procedures would have been of no benefit to them. Our bypass operations for ischemic lower extremities were classified as follows: those done between the abdominal aorta and the femoral artery in 17 cases, including those done between the aorta and the bifemoral arteries with a Y graft in four of those cases and long ones done from the axillary to the femoral artery in 4 cases. Five patients died in the hospital following vascular surgery for ischemic lower extremities, the causes of death were not directly related to the vascular reconstructive operative procedures. The leading causes of death were respiratory failure due to metastatic lung carcinoma: renal failure due to complications from atherosclerosis obliterans; sepsis from open, contaminated fractures of the tibia and fibula; and myocardial failures due to open heart surgery in one case and reconstructive surgery of the ascending aorta in another.

• Journal of Chest Surgery
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• v.14 no.1
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• pp.63-66
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• 1981

True aneurysm of the carotid artery is relatively rare in comparison with the total number of aneurysms of the arterial system. The threat of rupture and embolization from mural thrombi are indications for treatment even though no symptoms may be present. Resection of the aneurysm and restoration of arterial continuity is the treatment of choice. A case of aneurysm of the Lt. common carotid artery of a 21 year-old male patient is presented. The confirmatory diagnosis was made by left carotid angiogram, and the aneurysmectomy & reconstruction with woven dacron vascular prosthesis was done, while cerebral circulation was maintained by internal shunt.

• Journal of Chest Surgery
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• v.27 no.2
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• pp.153-156
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• 1994

Bentall`s operation for repair of annuloaortic ectasia has been associated with postoperative bleeding and with false aneurysm of the anastomotic site between the coronary orifice and composite graft.Among 5 cases, 2 cases have been operated direct anastomosis between coronary artery and vascular graft.Remained 3 cases have been operated with doughnutlike Teflon felt buttress.The technique of sandwiching the freed button of aortic wall bearing the coronary artery ostium between an outer Teflon felt doughnutlike buttress and the inner composite graft provides a leak-proof anastomosis.We experienced one case reoperation for bleeding at coronary anastomotic site above method.